Cardiac catheterizations are an important tool for modern cardiology
The term catheterization comes from the word catheter. The catheter is the plastic tube used during the procedure to let tools reach inside the patient’s body. Catheterization is different from standard surgery, where doctors cut the skin with a scalpel for access to the body. In a catheterization, everything happens through a small incision made with a needle.
Advertisement
Cardiac catheterizations are part of a group of procedures called "minimally invasive". Minimally invasive procedures offer a much smaller risk of infection and a quicker recovery than classic surgery. Cardiac caths do not involve general anesthesia, so the patient is not put to sleep. Instead, they are done under sedation and local anesthesia. The patient stays awake, but is given medication to help stay calm and comfortable. Then local anesthesia is injected under the skin where the catheter will enter the body. The technology in cardiac caths was invented in the 1940s, and caths have been done routinely since the 1980s. Cardiac caths are done by a sub-specialist known as an invasive cardiologist, and performed in a special operating room-like facility called a catheterization laboratory. Today, over one million are done in the United States every year.
Cardiac caths are used in many ways and can be divided into two main groups: diagnostic or therapeutic
They can be used to deliver contrast dye into the coronary arteries of the heart to check for blockages. This is called an angiography of the heart.
Once a blockage has been found, a cath can help slide an inflatable balloon through it to open it up. This is called a coronary angioplasty.
Caths can help set and deliver a stent into a blockage in an artery and leave it permanently open. This is called a percutaneous coronary intervention (P.C.I. for short).
During a cath, doctors can shoot a burst of contrast dye into the left ventricle and watch it squeeze it out into the body. This shows how well the heart is squeezing and working. This is called an LV-gram.
Contrast dye can also be shot into the aorta to help estimate if an enlargement or dissection is present. This is known as an aortogram.
Other procedures that can be done through a cath include:
T.A.V.R. or minimally invasive aortic valve replacement
Septal ablations, a procedure that can help in the treatment of symptoms related to abnormal thickening of the heart
Installation of the mitral clips, which are used to repair to leaky valves, among other things
The cardiac cath can be on either the right or left side of the heart. Right heart caths examine how hard the heart is working and measure the pressure inside the lungs. This information is useful for patients who struggle with heart failure and pulmonary hypertension. Left heart caths are used to get access to the coronaries, the arteries that give blood to the heart. They also help measure the strength of the heart muscle and how well the valves are working.
Are cardiac catheterizations safe?
Cardiac Caths are safe procedures. The average risk of complications from a coronary catheterization is well under 1%. That means that less than one person in every one hundred will have any trouble with a catheterization. Most complications are caused by damage to the arteries where the catheters are inserted. This can result in bleeding and bruising at the site. Some patients can also suffer an allergic reaction from the contrast dye that is used during the procedure.
Contrast dye is the liquid used to “see” the arteries.
Contrast dye is injected into the body during the cath and then filtered out of the body by the kidneys. Before any planned cath, doctors check a full panel of blood work to make sure the kidneys are healthy enough to get rid of the contrast dye. This blood work also checks that the patient is well in other ways, such as not fighting an infection and with blood that clots properly. If the kidneys are not healthy before a cath, doing one may make them worse. The patient may need to take special steps to make sure the kidneys are not harmed during the procedure.
There are three possible results from an elective coronary catheterization:
The arteries look normal or close to normal and without major blockages.
In that case, the patient will probably recover for a couple of hours and then go home the same day.
The doctor finds a major blockage that explains the patient’s symptoms
If that is the case, the blockage will be cleared with a stent. The patient will stay the night in the hospital and be monitored. Blood work will be repeated to make sure the kidneys tolerated the procedure, and if everything else looks good, the patient goes home the next day.
The coronary cath shows many major blockages
The doctor will likely stop the procedure after collecting as much information about the heart as possible, then allow the patient to recover. The case will then be reviewed by a team of doctors, including the cardiologist, the interventional cardiologist and a surgeon to decide which approach is best: either fixing the blockages with multiple stents or through surgery.
How are Cardiac Caths Done?
The day before the cath, a nurse will call you and review the medication you take. She will also tell you what to take the day of the procedure. When you arrive for the cath, the lab staff will set you up on the cath table, hook you up to the heart monitor and make sure your IV is working. You will receive medication that will help you relax and maybe even sleep during the cath. But don’t be surprised if you stay awake, as this is not unusual. The site where the catheter will be placed is then numbed. This is done by injecting medication around the area with a syringe. Once the area is numbed, a needle will be used to reach one of your arteries. Once the needle is inside the artery, it will be replaced with a sheath. The sheath will be the main portal into your body. Everything the doctor needs to study and treat your heart will enter through the sheath. The catheter is inserted next. It will travel through the arteries of your body to your heart, all through that same little incision.
About the Authors
AND
Share this with a patient or friend
Advertisement