Cardiac catheterization – Wikipedia

Cardiac catheterization (heart cath) is the insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes. Subsets of this technique are mainly coronary catheterization, involving the catheterization of the coronary arteries, and catheterization of cardiac chambers and valves of the cardiac system.

"Cardiac catheterization" is a general term for a group of procedures that are performed using this method, such as coronary angiography and left ventricle angiography. Once the catheter is in place, it can be used to perform a number of procedures including, coronary angioplasty, balloon septostomy, electrophysiology study or catheter ablation.

Procedures can be diagnostic or therapeutic. For example, coronary angiography is a diagnostic procedure that allows the interventional cardiologist to visualize the coronary vessels. Percutaneous coronary intervention, however, involves the use of mechanical stents to increase blood flow to previously blocked (or occluded) vessels. Other common diagnostic procedures include measuring pressures throughout the four chambers of the heart and evaluating pressure differences across the major heart valves. Interventional cardiologists can also use cardiac catheterization to estimate the cardiac output, the amount of blood pumped by the heart per minute.[1] Cardiac catheterization can be used as part of a therapeutic regimen to improve outcomes for survivors of out-of-hospital cardiac arrest.[2]

Cardiac catheterization requires the use of fluoroscopy to visualize the path of the catheter as it enters the heart or as it enters the coronary arteries. The coronary arteries are known as "epicardial vessels" as they are located in the epicardium, the outermost layer of the heart.[3] Fluoroscopy can be conceptually described as continuous x-rays. The use of fluoroscopy requires radiopaque contrast, which in rare cases can lead to contrast-induced kidney injury (see Contrast-induced nephropathy). Patients are constantly exposed to low doses of ionizing radiation during procedures.[4] Ideal table positioning between the x-ray source and receiver, and radiation monitoring via thermoluminescent dosimetry, are two main ways of reducing a person's exposure to radiation.[4] People with certain comorbidities (people who have more than one condition at the same time) have a higher risk of adverse events during the cardiac catheterization procedure.[4] These comorbidity conditions include aortic aneurysm, aortic stenosis, extensive three-vessel coronary artery disease, diabetes, uncontrolled hypertension, obesity, renal insufficiency, and unstable angina.[5]

There are two major categories of cardiac catheterization:[6]

Patients without cardiac symptoms or high-risk markers for a heart problem should not have a coronary catheterization to screen for problems.

Indications for cardiac catheterization include the following:

[8]

Right heart catheterization, along with pulmonary function testing and other testing should be done to confirm pulmonary hypertension prior to having vasoactive pharmacologic treatments approved and initiated.[9]

Catheterization of cardiac chambers and valves may be performed at the same time as a coronary catheterization, and may also involve nearby major vessels, such as the aorta. It is the main method of cardiac ventriculography (another being radionuclide ventriculography, whose use has largely been replaced by echocardiography).

Cardiac catheterization can be used to diagnose or assess severity of valvular stenosis by measuring elevated pressure gradients across cardiac valves.[10]

This is also the procedure used in balloon septostomy, which is the widening of a foramen ovale, patent foramen ovale (PFO), or atrial septal defect (ASD) using a balloon catheter.

Illustration depicting a catheter.

Illustration depicting a heart catheter.

Illustration depicting a catheter entering the coronary artery.

Illustration depicting left heart catheterization.

Illustration depicting right heart catheterization.

Illustration depicting a peripherally inserted central catheter vs. a midline catheter.

The history of cardiac catheterization dates back to Stephen Hales (1677-1761) and Claude Bernard (1813-1878), who both used it on animal models. Clinical application of cardiac catheterization begins with Werner Forssmann in 1929, who inserted a catheter into the vein of his own forearm, guided it fluoroscopically into his right atrium, and took an X-ray picture of it.[11] During World War II, Andr Frdric Cournand, a physician at NewYork-Presbyterian/Columbia, then Columbia-Bellevue, opened the first catheterization lab. In 1956, Forssmann and Dr. Cournand were co-recipients of the Nobel Prize in Physiology or Medicine for the development of cardiac catheterization. However, even after this achievement, hospital administrators removed Forssmann from his position owing to his unorthodox methods.[11]

Dr. Eugene A. Stead, founder of the Physician Assistant profession, also performed research in the 1940s which paved the way for cardiac catheterization in medicine today.

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Cardiac catheterization - Wikipedia