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Cardiac catheterization (heart cath) is the insertion of a
catheter In medicine Medicine is the science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity, awareness, or understanding of someone or something, such as facts ( descriptive knowledge) ...

catheter
into a chamber or vessel of the
heart The heart is a muscular MUSCULAR (DS-200B), located in the United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain,Usage is mixed. The Guardian' and Telegraph' use ...

heart
. This is done both for diagnostic and interventional purposes. A common example of cardiac catheterization is
coronary catheterization A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. It is performed for both diagnostic and interventional (treatment) purposes. Coronary cathet ...
that involves catheterization of the
coronary arteries The coronary arteries are the arterial blood vessels of coronary circulation Coronary circulation is the circulation of blood in the blood vessels that supply the cardiac muscle, heart muscle (myocardium). Coronary arteries supply oxygen saturat ...

coronary arteries
for
coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), or simply heart disease, involves the reduction of blood flow to the heart muscle Cardiac muscle (also called heart muscle or myocardium) i ...
and
myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow Hemodynamics American and British English spelling differences#ae and oe, or haemodynamics are the Fluid dynamics, dynamics of blood flow. The circulatory sy ...

myocardial infarction
s ("heart attacks"). Catheterization is most often performed in special laboratories with
fluoroscopy Image:Normal barium swallow animation.gif, A barium swallow exam taken via fluoroscopy. Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical i ...

fluoroscopy
and highly maneuverable tables. These "cath labs" are often equipped with cabinets of catheters,
stent In medicine Medicine is the Art (skill), art, science, and Praxis (process) , practice of caring for a patient and managing the diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment or Palliative care , palliation of their ...

stent
s,
balloons A balloon is a flexible bag that can be inflated with a gas, such as helium, hydrogen, nitrous oxide, oxygen, and Atmosphere of Earth, air. For special tasks, balloons can be filled with smoke, liquid water, granular media (e.g. sand, flour ...
, etc. of various sizes to increase efficiency. Monitors show the fluoroscopy imaging,
electrocardiogram Electrocardiography is the process of producing an electrocardiogram (ECG or EKG). It is a graph of voltage Voltage, electric potential difference, electromotive force emf, electric pressure or electric tension is the difference in elec ...

electrocardiogram
(ECG), pressure waves, and more.


Uses

Coronary angiography is a diagnostic procedure that allows visualization of the coronary vessels. Fluoroscopy is used to visualize the lumens of the arteries as a 2-D projection. Should these arteries show narrowing or blockage, then techniques exist to open these arteries.
Percutaneous coronary intervention Percutaneous coronary intervention (PCI) is a non-surgical procedure used to treat narrowing of the coronary arteries The coronary arteries are the arterial blood vessels of coronary circulation, which transport oxygenated blood to the heart m ...
is a blanket term that involves the use of mechanical stents, balloons, etc. to increase blood flow to previously blocked (or occluded) vessels. Measuring pressures in the heart is also an important aspect of catheterization. The catheters are fluid filled conduits that can transmit pressures to outside the body to
pressure transducer 200px, Miniature digital barometric pressure sensor A pressure sensor is a device for pressure measurement Pressure measurement is the analysis of an applied force by a fluid (liquid or gas) on a surface. Pressure is typically measured in ...
s. This allows measuring pressure in any part of the heart that a catheter can be maneuvered into. Measuring blood flow is also possible through several methods. Most commonly, flows are estimated using the
Fick principle The Fick principle states that blood flow to an organ can be calculated using a marker substance if the following information is known: * Amount of marker substance taken up by the organ per unit time * Concentration of marker substance in arterial ...
and thermodilution. These methods have drawbacks, but give invasive estimations of the cardiac output, which can be used to make clinical decisions (e.g.,
cardiogenic shock Cardiogenic shock (CS) is a medical emergency resulting from inadequate blood flow due to the dysfunction of the ventricles of the heart.Textbooks of Internal MedicinHarrison's Principles of Internal Medicine 16th Edition, The McGraw-Hill McG ...
,
heart failure Heart failure (HF), also known as congestive heart failure (CHF) and (congestive) cardiac failure (CCF), is a set of manifestations caused by the failure of the heart The heart is a cardiac muscle, muscular Organ (biology), organ in mo ...
) to improve the person's condition. Cardiac catheterization can be used as part of a therapeutic regimen to improve outcomes for survivors of out-of-hospital cardiac arrest. Cardiac catheterization often requires the use of
fluoroscopy Image:Normal barium swallow animation.gif, A barium swallow exam taken via fluoroscopy. Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical i ...

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. The use of fluoroscopy requires radiopaque contrast, which in rare cases can lead to contrast-induced kidney injury (see
Contrast-induced nephropathy Contrast-induced nephropathy (CIN) is a form of kidney damage in which there has been recent exposure to medical imaging contrast material without another clear cause for the acute kidney injury. CIN is classically defined as a serum creatinine ...
). People are constantly exposed to low doses of
ionizing radiation Ionizing radiation (or ionising radiation), including nuclear radiation, consists of s or s that have sufficient to s or s by detaching s from them. The particles generally travel at a speed that is greater than 1% of , and the electromagnetic w ...
during procedures. 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. People with certain
comorbidities In medicine Medicine is the Art (skill), art, science, and Praxis (process) , practice of caring for a patient and managing the diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment or Palliative care , palliation of their in ...

comorbidities
(people who have more than one condition at the same time) have a higher risk of adverse events during the cardiac catheterization procedure. These comorbidity conditions include
aortic aneurysm An aortic aneurysm is an enlargement (dilatation) of the aorta to greater than 1.5 times normal size. They usually cause no symptoms except when ruptured. Occasionally, there may be abdominal, back, or leg pain. They are most commonly located ...

aortic aneurysm
,
aortic stenosis Aortic stenosis (AS or AoS) is the narrowing of the exit of the left ventricle of the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the blood vessels of the circulatory system. T ...

aortic stenosis
, extensive three-vessel
coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), or simply heart disease, involves the reduction of blood flow to the heart muscle Cardiac muscle (also called heart muscle or myocardium) i ...
,
diabetes Diabetes mellitus, commonly known as just diabetes, is a group of metabolic disorder A metabolic disorder is a disorder that negatively alters the body's processing and distribution of macronutrients such as proteins, fats, and carbohydrate ...
, uncontrolled
hypertension Hypertension (HTN or HT), also known as high blood pressure (HBP), is a Chronic condition, long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High blood pressure usually does not ...

hypertension
,
obesity Obesity is a medical condition A disease is a particular abnormal condition that negatively affects the structure or function (biology), function of all or part of an organism, and that is not due to any immediate external injury. ...

obesity
,
chronic kidney disease Chronic kidney disease (CKD) is a type of kidney disease Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease A disease is a particular abnormal condition that negatively affects the str ...
, and
unstable angina Unstable angina (UA), also called crescendo angina, is a type of angina pectoris Angina, also known as angina pectoris, is chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp ...
.


Left heart catheterization

Left heart catheterization (LHC) is an ambiguous term and sometime clarification is required: * LHC can mean measuring the pressures of the left side of the heart. * LHC can be synonymous with coronary angiography. technique is also used to assess the amount of occlusion (or blockage) in a coronary artery, often described as a percentage of occlusion. A thin, flexible wire is inserted into either the
femoral artery The femoral artery is a large in the and the main arterial supply to the thigh and leg. The femoral artery gives off the deep femoral artery or and descends along the anteromedial part of the thigh in the . It enters and passes through the , ...
or the
radial artery In human anatomy The human body is the structure of a human being Humans (''Homo sapiens'') are the most populous and widespread species In biology, a species is the basic unit of biological classification, classification and a ...

radial artery
and threaded toward the heart until it is in the ascending
aorta The aorta ( ) is the main and largest artery An artery (plural arteries) () is a blood vessel The blood vessels are the components of the circulatory system The circulatory system, also called the cardiovascular system or the vas ...

aorta
. Radial access is not associated with an increased risk of stroke over femoral access. At this point, a catheter is guided over the wire into the ascending aorta, where it can be maneuvered into the coronary arteries through the coronary ostia. In this position, the interventional cardiologist can inject contrast and visualize the flow through the vessel. If necessary, the physician can utilize percutaneous coronary intervention techniques, including the use of a
stent In medicine Medicine is the Art (skill), art, science, and Praxis (process) , practice of caring for a patient and managing the diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment or Palliative care , palliation of their ...

stent
(either bare-metal or ) to open the blocked vessel and restore appropriate blood flow. In general, occlusions greater than 70% of the width of the vessel lumen are thought to require intervention. However, in cases where multiple vessels are blocked (so-called "three-vessel disease"), the interventional cardiologist may opt instead to refer the patient to a cardiothoracic surgeon for coronary artery bypass graft (CABG; see
Coronary artery bypass surgery Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage") surgery, and colloquially heart bypass or bypass surgery, is a surgical procedure to reperfusion therapy, restore normal blood flow to an obs ...
) surgery.


Right heart catheterization

Right heart catheterization (RHC) allows the physician to determine the pressures within the heart (intracardiac pressures). The heart is most often accessed via the internal jugular or femoral vein; arteries are not used. Values are commonly obtained for the right atrium, right ventricle, pulmonary artery, and pulmonary capillary "wedge" pressures. Right heart catheterizations also allow the physician to estimate the cardiac output, the amount of blood that flows from the heart each minute, and the cardiac index, a hemodynamic parameter that relates the cardiac output to a patient's body size. Determination of cardiac output can be done by releasing a small amount of saline solution (either chilled or at room temperature) in one area of the heart and measuring the change in blood temperature over time in another area of the heart. Right heart catheterization is often done for
pulmonary hypertension Pulmonary hypertension (PH or PHTN) is a condition of increased blood pressure within the arteries of the lungs. Symptoms include shortness of breath, syncope, tiredness, chest pain, pedal edema, swelling of the legs, and a fast heartbeat. The ...
,
heart failure Heart failure (HF), also known as congestive heart failure (CHF) and (congestive) cardiac failure (CCF), is a set of manifestations caused by the failure of the heart The heart is a cardiac muscle, muscular Organ (biology), organ in mo ...
, and
cardiogenic shock Cardiogenic shock (CS) is a medical emergency resulting from inadequate blood flow due to the dysfunction of the ventricles of the heart.Textbooks of Internal MedicinHarrison's Principles of Internal Medicine 16th Edition, The McGraw-Hill McG ...
. The pulmonary artery catheter can be placed, used, and removed, or it can be placed and left in place for continuous monitoring. The latter can be done an
intensive care unit 220px, Intensive care unit An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensiv ...
(ICU) to permit frequent measurement of the hemodynamic parameters in response to interventions. Parameters obtainable from a right heart catheterization: * Right atrial pressure * Right ventricular pressure * Pulmonary artery pressure * Pulmonary capillary wedge pressure * Systemic vascular resistance * Pulmonary vascular resistance * Cardiac output * Blood oxygenation Implantation of a CardioMEMS is done during a right heart catheterization. This device is implanted into the pulmonary artery to permit real-time measurement of the pulmonary artery pressure over time.


Coronary catheterization

Coronary catheterization is an invasive process and comes with risks that include stroke, heart attack, and death. Like any procedure, the benefits should outweigh the risks and so this procedure is reserved for those with symptoms of serious heart diseases and is never used for screening purposes. Other, non-invasive tests are better used when the diagnosis or certainty of the diagnosis is not as clear. Indications for cardiac catheterization include the following: *
Acute coronary syndrome Acute coronary syndrome (ACS) is a syndrome (a set of signs and symptoms) due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies. The most common symptom is centrally l ...
s: ST elevation MI (STEMI), non-ST Elevation MI (NSTEMI), and unstable angina * Evaluation of
coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), or simply heart disease, involves the reduction of blood flow to the heart muscle Cardiac muscle (also called heart muscle or myocardium) i ...
as indicated by ** Abnormal stress test ** As part of the pre-op evaluation for other cardiac procedures (e.g., valve replacement) as
coronary artery bypass graft Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage") surgery, and colloquially heart bypass or bypass surgery, is a surgical procedure to restore normal blood flow to an obstructed coronary ar ...
ing may be done at the same time ** Risk stratification for high cardiac risk surgeries (e.g.,
endovascular aneurysm repair Endovascular aneurysm repair (EVAR), is a type of minimally-invasive endovascular surgery Vascular surgery is a surgical subspecialty in which diseases of the vascular system, or artery, arteries, veins and lymphatic circulation, are managed by ...
) * Persistent chest pain despite medical therapy thought to be cardiac in origin * New-onset unexplained heart failure * Survival of
sudden cardiac death Cardiac arrest is a sudden loss of blood flow resulting from the failure of the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the blood vessels of the circulatory system. The pump ...
or dangerous cardiac arrhythmias * Workup of suspected Prinzmetal angina ( coronary vasospasm) Right heart catheterization, along with
pulmonary function testing Pulmonary function testing (PFT) is a complete evaluation of the respiratory system including patient history, physical examinations, and tests of pulmonary function. The primary purpose of pulmonary function testing is to identify the severity ...
and other testing should be done to confirm
pulmonary hypertension Pulmonary hypertension (PH or PHTN) is a condition of increased blood pressure within the arteries of the lungs. Symptoms include shortness of breath, syncope, tiredness, chest pain, pedal edema, swelling of the legs, and a fast heartbeat. The ...
prior to having
vasoactive A vasoactive substance is an endogenous agent or pharmaceutical drug that has the effect of either increasing or decreasing blood pressure and/or heart rate through its vasoactivity, that is, vascular activity (effect on blood vessel The b ...
pharmacologic treatments approved and initiated. * to measure intracardiac and
intravascular The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away ...
blood pressure Blood pressure (BP) is the pressure Pressure (symbol: ''p'' or ''P'') is the force In physics Physics is the natural science that studies matter, its Elementary particle, fundamental constituents, its Motion (physics), motio ...

blood pressure
s * to take tissue samples for
biopsy A biopsy is a medical test A medical test is a medical procedureA medical procedure is a course of action intended to achieve a result in the delivery of healthcare. A medical procedure with the intention of determining, measuring, or diagno ...

biopsy
* to inject various agents for measuring blood flow in the heart; also to detect and quantify the presence of an intracardiac shunt * to inject
contrast agents A contrast agent (or contrast medium) is a substance Substance may refer to: * Substance (Jainism), a term in Jain ontology to denote the base or owner of attributes * Chemical substance, a material with a definite chemical composition * Matter, any ...
in order to study the shape of the heart vessels and chambers and how they change as the heart beats


Pacemakers and defibrillators

Placement of internal
pacemaker A cardiac pacemaker (or artificial pacemaker, so as not to be confused with the natural pacemaker of the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the blood vessels of the cir ...
s and
defibrillator Defibrillation is a treatment for life-threatening cardiac dysrhythmia Arrhythmia, also known as cardiac arrhythmia or heart arrhythmia, is a group of conditions in which the heartbeat is irregular, too fast, or too slow. The heart rate tha ...

defibrillator
s are done through catheterization as well. An exception to this is placement of electrodes on the outer surface of the heart (called epicardial electrodes). Otherwise, electrodes are place through the venous system into the heart and left there permanently. Typically, these devices are placed in the left upper chest and enter the left
subclavian vein The subclavian vein is a paired large vein Veins are blood vessels The blood vessels are the components of the circulatory system The circulatory system, also called the cardiovascular system or the vascular system, is an Biological sys ...
and electrodes are placed in the right atrium, right ventricle, and coronary sinus (for the left ventricle stimulation).


Valve assessment

Echocardiography An echocardiography, echocardiogram, cardiac echo or simply an echo, is an ultrasound Ultrasound is s with higher than the upper audible limit of human . Ultrasound is not different from "normal" (audible) sound in its physical properties ...
is a non-invasive method to evaluate the heart valves. However, sometimes the valve pressure gradients need to be measured directly because echo is equivocal for the severity of valve disease. Invasive assessment of the valve can be done with catheterization by placing a catheter across the valve and measuring the pressures simultaneously on each side of the valve to obtain the pressure gradient.Grossman & Baim's cardiac catheterization, angiography, and intervention. Moscucci, Mauro, (Eighth edition). Philadelphia. p. 272. . OCLC 829739969. In conjunction with a right heart catheterization, the valve area can be estimated. For example, in aortic valve area calculation the Gorlin equation can be used to calculate the area if the cardiac output, pressure gradient, systolic period, and heart rate are known.


Pulmonary angiography

Evaluation of the blood flow to the lungs can be done invasively through catheterization. Contrast is injected into the pulmonary trunk, left or right pulmonary artery, or segment of the pulmonary artery.


Shunt evaluation

Cardiac shuntA cardiac shunt is a pattern of blood flow in the heart that deviates from the normal circuit of the circulatory system The circulatory system, also called the cardiovascular system or the vascular system, is an organ system that permits blood t ...
s can be evaluated through catheterization. Using oxygen as a marker, the
oxygen saturation Oxygen saturation (symbol SO2) is a relative measure of the concentration of oxygen that is Dissolution (chemistry), dissolved or carried in a given medium as a proportion of the maximal concentration that can be dissolved in that medium. It can ...
of blood can be sampled at various locations in and around the heart. For example, a left-to-right
atrial septal defect Atrial septal defect (ASD) is a congenital heart defect A congenital heart defect (CHD), also known as a congenital heart anomaly and congenital heart disease, is a defect in the structure of the heart The heart is a cardiac muscle, mu ...

atrial septal defect
will show a marked increase in oxygen saturation in the right atrium, ventricle, and pulmonary artery as compared to the mixed venous oxygen saturation from the oxygenated blood from the lungs mixing into the venous return to the heart. Utilizing the
Fick principle The Fick principle states that blood flow to an organ can be calculated using a marker substance if the following information is known: * Amount of marker substance taken up by the organ per unit time * Concentration of marker substance in arterial ...
, the ratio of blood flow in the lungs (Qp) and system circulations (Qs) can calculate the Qp:Qs ratio. Elevation of the Qp:Qs ratio above 1.5 to 2.0 suggests that there is a hemodynamically significant left-to-right shunt (such that the blood flow through the lungs is 1.5 to 2.0 times more than the systemic circulation). This ratio can be evaluated non-invasively with
echocardiography An echocardiography, echocardiogram, cardiac echo or simply an echo, is an ultrasound Ultrasound is s with higher than the upper audible limit of human . Ultrasound is not different from "normal" (audible) sound in its physical properties ...
too, however. A "shunt run" is often done when evaluating for a shunt by taking blood samples from
superior vena cava The superior vena cava (SVC) is the anatomical terms of location#Superior and inferior, superior of the two venae cavae, the great vein, venous trunks that return deoxygenated blood from the circulatory system, systemic circulation to the atrium ...
(SVC),
inferior vena cava The inferior vena cava is a large vein that carries the deoxygenated blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressible fluid In physics, a fluid is a substance th ...

inferior vena cava
(IVC),
right atrium The atrium (Latin ātrium, “entry hall”) is the upper chamber through which blood enters the Ventricle (heart), ventricles of the heart. There are two atria in the human heart – the left atrium receives blood from the pulmonary (lung) circul ...
,
right ventricle A ventricle is one of two large chambers toward the bottom of the heart The heart is a cardiac muscle, muscular Organ (biology), organ in most animals, which pumps blood through the blood vessels of the circulatory system. The pumped blood ...
,
pulmonary artery A pulmonary artery is an artery An artery (plural arteries) () is a blood vessel that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are t ...

pulmonary artery
, and system arterial. Abrupt increases in oxygen saturation support a left-to-right shunt and lower than normal systemic arterial oxygen saturation supports a right-to-left shunt. Samples from the SVC & IVC are used to calculate mixed venous oxygen saturation.


Ventriculography

By injecting contrast into the left ventricle, the outline of the ventricle can be measured in both systole and diastole to estimate the
ejection fraction An ejection fraction (EF) is the volumetric fraction A fraction (from Latin ', "broken") represents a part of a whole or, more generally, any number of equal parts. When spoken in everyday English, a fraction describes how many parts of a certa ...
(a marker of heart function). Due to the high contrast volumes and injection pressures, this is often not performed unless other, non-invasive methods are not acceptable, not possible, or conflicting.


Percutaneous aortic valve replacement

Advancements in cardiac catheterization have permitted replacement of heart valves by means of blood vessels. This method allows
valve replacement Valve replacement surgery is the replacement of one or more of the heart valves with either an artificial heart valve An artificial heart valve is a one-way valve implanted into a person's heart The heart is a muscle, muscular Organ ...
without
open heart surgery ''Open Heart Surgery'' is an album by the rock band Virginwool, released in 2000 via Breaking/Atlantic Records. The album is out of print. "I Think Her Mother Loves Me" was the first single from the album; a remixed, slightly poppier version was ...
and can be performed on people who are high-risk for such a surgery.


Balloon septostomy

Catheterization can also be used to perform
balloon septostomy A balloon is a flexible bag that can be inflated with a gas, such as helium, hydrogen, nitrous oxide, oxygen, and Atmosphere of Earth, air. For special tasks, balloons can be filled with smoke, liquid water, granular media (e.g. sand, flour ...
, which is the widening of a foramen ovale,
patent foramen ovale Atrial septal defect (ASD) is a congenital heart defect in which blood flows between the atria (upper chambers) of the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the blood vess ...
(''PFO''), or
atrial septal defect Atrial septal defect (ASD) is a congenital heart defect A congenital heart defect (CHD), also known as a congenital heart anomaly and congenital heart disease, is a defect in the structure of the heart The heart is a cardiac muscle, mu ...

atrial septal defect
(''ASD'') using a
balloon catheter A balloon catheter is a type of "soft" catheter with an inflatable "balloon" at its tip which is used during a catheterization procedure to enlarge a narrow opening or passage within the body. The deflated balloon catheter is positioned, then inf ...
. This can be done in certain congenital heart diseases in which the mechanical shunting is required to sustain life such as in
transposition of the great vessels Transposition of the great vessels (TGV) is a group of congenital heart defects involving an abnormal spatial arrangement of any of the great vessels: superior and/or inferior venae cavae, pulmonary artery A pulmonary artery is an artery ...
.


Alcohol septal ablation

Hypertrophic cardiomyopathy Hypertrophic cardiomyopathy (HCM) is a condition in which the heart becomes hypertrophy, thickened without an obvious cause. The parts of the heart most commonly affected are the interventricular septum and the ventricles. This results in the hea ...
is a disease in which the myocardium is thickened and can cause blood flow obstruction. If hemodynamically significant, this excess muscle can be removed to improve blood flow. Surgically, this can be done with septal myectomy. However, it can be done through catheterization and by injecting
ethanol Ethanol (also called ethyl alcohol, grain alcohol, drinking alcohol, or simply alcohol) is an organic Organic may refer to: * Organic, of or relating to an organism, a living entity * Organic, of or relating to an anatomical organ (anatomy), ...

ethanol
to destroy the tissue in an
alcohol septal ablation Alcohol septal ablation (ASA) is a percutaneous, minimally invasive procedure performed by an interventional cardiologist to relieve symptoms and improve functional status in eligible patients with severely symptomatic hypertrophic cardiomyopathy (H ...
. This is done by selected an appropriate septal artery supplying the intended area and, essentially, causing a localized, controlled
myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow Hemodynamics American and British English spelling differences#ae and oe, or haemodynamics are the Fluid dynamics, dynamics of blood flow. The circulatory sy ...

myocardial infarction
of the area with ethanol.


Complications

Complications of cardiac catheterization and tools used during catheterization include, but not limited to: * Death * Stroke * Heart attack * Ventricular ectopy and
ventricular arrhythmia Arrhythmia, also known as cardiac arrhythmia or heart arrhythmia, is a group of conditions in which the is irregular, too fast, or too slow. The that is too fast – above 100 beats per minute in adults – is called , and a heart rate that i ...
s *
Pericardial effusion A pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity The pericardium, also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. It has two layers, an outer laye ...

Pericardial effusion
* Bleeding: internal and external * Infection * Radiation burn * Contrast induced nephropathy from contrast use The likelihood of these risks depends on many factors that include the procedure being performed, the overall health state of the patient, situational (elective vs emergent), medications (e.g.,
anticoagulation Anticoagulants, commonly known as blood thinners, are chemical substances that prevent or reduce coagulation of blood, prolonging the clotting time. Some of them occur naturally in blood-eating animals such as leeches and mosquito A mosqu ...
), and more.


Procedure

"Cardiac catheterization" is a general term for a group of procedures. Access to the heart is obtained through a peripheral artery or vein. Commonly, this includes the
radial artery In human anatomy The human body is the structure of a human being Humans (''Homo sapiens'') are the most populous and widespread species In biology, a species is the basic unit of biological classification, classification and a ...

radial artery
,
internal jugular vein The internal jugular vein is a paired jugular vein The jugular veins are vein Veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary vei ...
, and
femoral artery The femoral artery is a large in the and the main arterial supply to the thigh and leg. The femoral artery gives off the deep femoral artery or and descends along the anteromedial part of the thigh in the . It enters and passes through the , ...
/
vein Veins are blood vessels The blood vessels are the components of the circulatory system The circulatory system, also called the cardiovascular system or the vascular system, is an organ system An organ system is a biological system A b ...
. Each blood vessel has its advantages and disadvantages. Once access is obtained, plastic catheters (tiny hollow tubes) and flexible wires are used to navigate to and around the heart. Catheters come in numerous shapes, lengths, diameters, number of lumens, and other special features such as electrodes and balloons. Once in place, they are used to measure or intervene. Imaging is an important aspect to catheterization and commonly includes fluoroscopy but can also include forms of
echocardiography An echocardiography, echocardiogram, cardiac echo or simply an echo, is an ultrasound Ultrasound is s with higher than the upper audible limit of human . Ultrasound is not different from "normal" (audible) sound in its physical properties ...
( TTE,
TEE Tee, tees, or TEE may refer to: Common meaning *, an item of sports equipment, used a.o. in golf *, a language spoken in Nigeria *, a shell command in various operating systems *, symbol used in mathematics, logic and computer science *, or tee ...
,
ICE Ice is water Water (chemical formula H2O) is an , transparent, tasteless, odorless, and , which is the main constituent of 's and the s of all known living organisms (in which it acts as a ). It is vital for all known forms of , eve ...
) and ultrasound (
IVUS Intravascular ultrasound (IVUS) is a medical imaging Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organ ...
). Obtaining access uses the
Seldinger technique The Seldinger technique, also known as Seldinger wire technique, is a medical procedureA medical procedure is a course of action intended to achieve a result in the delivery of healthcare. A medical procedure with the intention of determining, mea ...
by puncturing the vessel with a needle, placing a wire through the needle into the lumen of the vessel, and then exchanging the needle for a larger plastic sheath. Finding the vessel with a needle can be challenging and both ultrasound and fluoroscopy can be used to aid in finding and confirming access. Sheaths typically have a side port that can be used to withdraw blood or injection fluids/medications, and they also have an end hole that permits introducing the catheters, wires, etc. coaxially into the blood vessel. Once access is obtained, what is introduced into the vessel depends on the procedure being performed. Some catheters are formed to a particular shape and can really only be manipulated by inserting/withdrawing the catheter in the sheath and rotating the catheter. Others may include internal structures that permit internal manipulation (e.g., intracardiac echocardiography). Finally, when the procedure is completed, the catheters are removed and the sheath is removed. With time, the hole made in the blood vessel will heal. Vascular closure devices can be used to speed along hemostasis.


Equipment

Much equipment is required for a facility to perform the numerous possible procedures for cardiac catheterization. General: * Catheters * Film or Digital Camera * Electrocardiography monitors * External defibrillator * Fluoroscopy * Pressure transducers * Sheaths Percutaneous coronary intervention: *
Coronary stent A coronary stent is a tube-shaped device placed in the coronary arteries that supply blood Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrient A nutrient is a substance used by an organism ...
s:
bare-metal stent Bare-metal stent is a stent In medicine Medicine is the Art (skill), art, science, and Praxis (process) , practice of caring for a patient and managing the diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment or Palliative ...
(BMS) and
drug-eluting stent A drug-eluting stent (DES) is a peripheral or coronary stent A coronary stent is a tube-shaped device placed in the coronary arteries that supply blood Blood is a body fluid in humans and other animals that delivers necessary substance ...

drug-eluting stent
(DES) *
Angioplasty Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis ...
balloons *
Atherectomy Atherectomy is a minimally invasive endovascular surgery technique for removing atherosclerosis Atherosclerosis is a disease in which the wall of the artery An artery (plural arteries) () is a blood vessel that takes blood away from the he ...
lasers and rotational devices * Left atrial appendage occlusion devices Electrophysiology: *
Ablation Ablation is removal or destruction of material from an object by vaporization, chipping, or other erosion, erosive processes. Examples of ablative materials are described below, and include spacecraft material for ascent and atmospheric reentry, ...
catheters: radiofrequency (RF) and cryo *
Pacemaker A cardiac pacemaker (or artificial pacemaker, so as not to be confused with the natural pacemaker of the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the blood vessels of the cir ...
s *
Defibrillator Defibrillation is a treatment for life-threatening cardiac dysrhythmia Arrhythmia, also known as cardiac arrhythmia or heart arrhythmia, is a group of conditions in which the heartbeat is irregular, too fast, or too slow. The heart rate tha ...

Defibrillator
s


History

The history of cardiac catheterization dates back to
Stephen Hales Stephen Hales (17 September 16774 January 1761) was an English clergyman who made major contributions to a range of scientific fields including botany Botany, also called , plant biology or phytology, is the science Science (from th ...

Stephen Hales
(1677-1761) and
Claude Bernard Claude Bernard (; 12 July 1813 – 10 February 1878) was a French French (french: français(e), link=no) may refer to: * Something of, from, or related to France France (), officially the French Republic (french: link=no, République fra ...

Claude Bernard
(1813-1878), who both used it on animal models. Clinical application of cardiac catheterization begins with Dr.
Werner Forssmann Werner Theodor Otto Forßmann (Forssmann in English; 29 August 1904 – 1 June 1979) was a physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simp ...

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 An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation In physics Physics is the natural science that studies matter, its Elementary particle, fundamental constituents, its Moti ...

X-ray
picture of it. However, even after this achievement, hospital administrators removed Forssmann from his position owing to his unorthodox methods. During
World War II World War II or the Second World War, often abbreviated as WWII or WW2, was a global war A world war is "a war War is an intense armed conflict between states State may refer to: Arts, entertainment, and media Literatur ...
, André Frédéric Cournand, a physician at NewYork-Presbyterian/Columbia, then Columbia-Bellevue, opened the first catheterization lab. In 1956, Forssmann and Cournand were co-recipients of the Nobel Prize in Physiology or Medicine for the development of cardiac catheterization. Dr. Eugene A. Stead performed research in the 1940s, which paved the way for cardiac catheterization in the USA.


References


External links


MedlinePlus Medical Encyclopedia: Cardiac catheterization


{{Authority control Cardiac procedures Medical tests